Friday, August 26, 2011

Adding Great Players To Our team

Baseball season is heading toward the playoffs, and the football regular season is almost upon us. What do these sports have in common with healthcare?  All require a group of individuals working together as a team to ensure success.

This week, GBMC HealthCare formally added new members to our team - a multi-provider practice in Perry Hall (Chapel View Family Care) and a solo physician practice in Lutherville (Dr. Joseph Pallan) have signed on as the charter partners for Greater Baltimore Health Alliance (GBHA), a network of employed and community-based clinician partners working collaboratively to provide better health and better care at a lower cost

GBHA was created as part of the organization’s recently-launched strategic plan which includes a vision (To every patient, every time, we will provide the care that we would want for our own loved ones”) for a system where a patient’s needs will be better met. GBHA aims to have 30 primary care and specialist physician practices as partners with our employed doctors in GBMA by 2012.

The backbone that is required to better oversee a patient’s health is a common electronic medical record system (eClinicalWorks) that will facilitate the exchange of health information, and help coordinate care among the practices, the hospital, Gilchrist Hospice Care and other future community partners.  GBHA will be providing practice management assistance to its partner providers, such as helping subsidize some of the costs of implementing the electronic record.

Leaders of Chapel View Family Care, a four-clinician family medicine practice on Bel Air Road that has served Baltimore and Harford counties since 1994 and handles approximately 17,000 patient visits annually, believe aligning with GBHA will enable them to successfully navigate healthcare reform and continue their history of taking care of multiple generations of families in their community. We are all honored that these outstanding clinicians chose to align with us rather than with one of the many other health systems that they could have chosen.

This week I was able to get out of the office and travel to Perry Hall to meet with the Chapel View providers and see firsthand how their use of the eClinicalWorks tool has made it easier for them to do their jobs and provide excellent care for patients. 

Chapel View physician Bradford Ebright, M.D. (seated) demonstrates the electronic medical record to (L-R): Patricia Chambliss, M.D.; Bob Adamczyk, P.A.; John Chessare, M.D. (President / CEO, GBMC); Kristine Salvo, M.D.

Chapel View physicians demonstrated how using these healthcare IT tools will allow for ease and efficiency in tracking data for patients.  For example, via an easily understood chart doctors can see how a patient’s blood pressure has progressed since a certain medication was started; when laboratory tests are ordered the results are automatically routed back to the patient’s electronic medical record; and prescriptions are electronically sent to pharmacies to be filled and available for pick-up when the patient arrives.

Our health care system takes great care of patients every day but we must do even better at coordinating that care, whether via physicians who are employed by GBMC or in private practice, and make things better thru the eyes of the patient.  Our strategy allows for the continued flourishing of the private practice of medicine for physicians who choose to run their own business.

 “We are excited about our relationship with Greater Baltimore Health Alliance because it allows us to partner with a larger medical system and readily exchange data with GBMC doctors to whom we refer our patients,” said Bradford Ebright, M.D., one of the Chapel View physicians.  “In doing this, we can optimize patient care but continue to remain a community based, independent practice that the patients in our community see as a medical home.

Joseph Pallan, M.D., believes aligning with Greater Baltimore Health Alliance will position him well for continuing his York Road solo practice as the changes mandated by healthcare reform unfold.  “This allows me as a physician to balance maintaining my independence while at the same time providing clinical coordination and integration of services,” said Dr. Pallan, a board-certified internal medicine physician who has been practicing for 10 years.

Have a minute?  Here’s a quick video of my visit to Chapel View and a demonstration of eClinicalWorks by Dr. Ebright.

On a final note, I’m proud to report that GBMC's Primary Stroke Center is the latest of our services to earn high marks for the excellent care that physicians, nurses and the rest of the team provide every day to our patients.  The center was recently recognized by the American Heart Association with a Gold Plus Quality Achievement Award for sustained clinical performance in stroke care for at least 24 months. Congratulations to our Stroke Team!

Friday, August 19, 2011

In Action to Improve Our Care

What if you went on vacation and when you got to your hotel room, you discovered there were no bath towels for you to use during your stay? That scenario is unacceptable. You need bath towels in the room where you’ll be bathing, and you didn’t bring your own. There’s a simple fix - call the front desk and ask them to deliver clean towels. Within a few minutes, a hotel employee will be at your room with the towels.

In a hospital setting, the scenario is much different. Caregivers enter patient rooms and often don’t find all the supplies they need. There is no “front desk” from which to order non-latex gloves, water for the patient’s bedside, or a remote control for the television. Instead, the caregiver has to leave the room to get the items and bring them back. In taking this action, the caregiver has unwittingly added extra steps to his or her process and an opportunity for hand hygiene failure is born.

I recently attended a meeting where the results of a hand hygiene value stream were reported. A multidisciplinary team spent three days studying why hand hygiene failures occur, looking at workflow processes on Unit 48 and trying to make hand hygiene compliance better by improving efficiency at the bedside.

Members of GBMC's TCAB Hand Hygiene Value Stream Team

The team looked at a typical surgical admission scenario and identified 14 opportunities for a single nurse to practice hand hygiene. The 51-minute admission process was affected by a lack of a standard room setup and the need to continually leave the room to get missing supplies, which resulted in more chances for someone to forget to wash their hands. The team learned that hand hygiene compliance is more complicated than just remembering to “wash in, wash out.” Hand hygiene failures are actually the result of poorly designed processes.

So, the group developed standard work for the processes they studied. They standardized forms, created a diagram of how a patient room should look before an admission and made a listing of necessary supplies for each room. These changes, along with several others, will be implemented and tested on Unit 48 over the next few months so that successes can be shared with other units.

Non-standardized room

Standardized Room Set-Up

I was excited to be present at the report out. It shows that we’re taking action to make changes. And I’m proud of the team that participated in this important work: Janet Achiro (U48), Rayna Bush (Transportation), Antonio Crossfield (EVS), Pat Forbes (U48), Ryan Gruver (Performance Improvement), Bridgette King (Hostess), Stephanie Mayoryk (Infection Prevention), Erin McCoy (Nursing Education), Eileen Skaarer (manager U48), Joyce Walters (Phlebotomy) and Jill Wheeler (Nurse Staffing). They were using continuous performance improvement to improve our care and reduce wasted steps for our nursing staff. See my blog posts from April 21, 2011 and February 18, 2011 to re-read the five tenets of continual improvement. Well-designed systems, like the ones being tested on Unit 48, will help us to achieve a high level of reliability to ensure safety and quality.

Do you see “broken” systems in your day-to-day job that need to be fixed in order to improve our reliability for providing safe, quality care? Share your thoughts in the comments section below, or make a suggestion to your manager for his or her monthly Zero Waste idea forms.

Finally, I want to take a moment to remember the lives of two men who helped to make GBMC the outstanding healthcare system it is today. Their generosity was truly inspirational.

William A. Kroh served on several GBMC boards and was also our patient. Mr. Kroh and his wife, Jarnetta, were instrumental in establishing the Kroh Center for Digestive Disorders at the hospital, which offers a multi-disciplinary approach for the diagnosis and treatment of disorders of the esophagus, stomach, small intestine, colon, pancreas, gallbladder and liver for both adults and children. Mr. Kroh passed away in July.

William E. Kahlert passed away last week. Also a patient of GBMC, he made one of the largest gifts by a living donor. This allowed GBMC to be at the cutting edge of clinical trials in urology through the organization’s first-ever endowed research chair. The William E. Kahlert Endowment for Urologic Research, led by Ronald Tutrone, MD, supports the research of prostate, bladder and kidney cancers, as well as other urological conditions.

Mr. Kroh and Mr. Kahlert will be deeply missed.

Friday, August 12, 2011

Working with Partners to Improve Health Care

Frequent readers of this blog know that I’m a fervent believer and advocate that significant change is the only way of escaping the quagmire we face in America’s healthcare system.  While we’re making some of these changes across the GBMC HealthCare system, we need more people in the boat with us to buy into the redesign of healthcare.

The state of Maryland has an overriding concern in making healthcare affordable and in insuring those who cannot insure themselves. The biggest part of the State budget dilemma this year was the cost of Medicaid.  Comptroller Peter Franchot recently visited GBMC at Hunt Valley – one of our 9 GBMA employed primary care sites (4 on campus and 5 off-site in the county) to see the innovations in action and learn how we are becoming more patient-centered and better able to coordinate the care of chronic disease.

There’s been an astronomical degree of change at the Hunt Valley practice to achieve better health and better care at lower cost. This is a trial site for our Greater Baltimore Medical Associates (GBMA) practices and it’s going very well.

GBMC is a great organization that has done great things but we want to be part of the local, regional and national healthcare solution.  Joining me from GBMC in meeting with Comptroller Franchot were our new Board Chairman Harry Johnson, and Dr. Mark Lamos, medical director of GBMA’s primary care physicians.

During the past six months, more than 8,000 paper medical records have been converted into electronic format; the practice has expanded its hours offering early mornings and later evening appointments to make healthcare more convenient for patients; and staff members have begun pre-appointment calls in the evenings and chart reviews to ensure all necessary labwork and other tests are completed in advance of a patient’s appointment. Hunt Valley has evening group visits for diabetic patients so they can learn from each other.  Thirty percent of appointments are available the day a patient calls, yet the slots are almost always 100 percent filled. CareFirst Blue Cross Blue Shield has also recognized the problems facing healthcare and is working closely with Hunt Valley as the practice has been redesigned into a level three Patient Centered Medical Home.

We were all very pleased that the comptroller seemed genuinely interested in learning more about how we are working to drive the waste out of healthcare and change from a transactional “fee for service” system of medicine to one based on preventative care and better coordination of chronic care. While currently there are no mechanisms in Maryland to reward systems for keeping patients out of hospitals, we’re hoping the state might recognize that we are pioneers and work with us as we continue redesigning care.

On a related note about the challenges facing healthcare, it was sad to see my colleague Jeff Norman last week announce his departure from St. Joseph Medical Center. While our careers in Baltimore only intersected for a short while, I grew to know Jeff as a professional of the highest level of ethics and trust and wish him the best in his future endeavors.

Do you have questions or comments? Please share your thoughts by commenting below.

Friday, August 5, 2011

1,300 Cupcakes, a Daughter’s Love, and a Father’s Legacy

A few months ago, the GBMC family was saddened by the loss of Dr. Peter Golueke, our Chief of Vascular Surgery. This week, I had the pleasure of meeting Peter’s daughter, Erin. To honor Peter, and his wonderful legacy of caring for our patients, the GBMC Foundation is raising money for the Peter J. Golueke, M.D. Lectureship in Vascular Surgery. Erin, a senior at Roland Park Country School, wanted to get in action to help maintain her father’s legacy and also to help vascular surgery patients at GBMC. So, as part of her senior project, she (and her friend Allie pictured with me and Erin below) baked 1,300 cupcakes and raised $2,500 for the lectureship! It was wonderful to meet Erin and Allie. Out of a very sad and difficult event for Erin and her family, she found the strength to get in action and do something good. Erin’s work will further her Father’s legacy and do good for others. The lesson for us all in this is that lamenting our lot in life, talking about the need for change, or standing on the sidelines and waiting for someone to make things better gets us nowhere – we must act to make things better.

Erin (on the left in the photo) and her classmate Allie Mason present me with a check.

In another story that was more about yelling and arguing about a problem rather than getting in action on real change, this week saw Congress act to raise the debt ceiling in hopes of avoiding a historic negative financial event in American history. The passage of the legislation only occurred after weeks of political posturing and fighting between members of Congress. I was amazed at how much our elected officials were relying on their own beliefs and ignoring the recommendations of learned economists. I was reminded of a line in the song Reeling in the Years, by Steely Dan…..”the things that pass for knowledge I can’t understand”. We are now headed down a road of drastically cutting federal expenses and putting the economy at further risk. There is absolutely no one who believes that the U.S. can continue to have deficit spending - the national debt is too big and we must reduce it. However, trying to fix a problem that started in 2001 (the last budget surplus was with President Clinton in 2000) with drastic spending cuts with 9% of Americans already out of work, makes no sense. We need a more measured response that gradually reduces spending while letting the economy grow.

Be that as it may, the enacted legislation will force expense cuts in entitlement programs like Medicare and this will have a negative effect on healthcare systems like GBMC. Don’t get me wrong. We must reign in Medicare spending. We must reign in all of our national expenditures on health care. The chart below was recently released by The Commonwealth Fund using the data of the Organization for Economic Cooperation and Development. It shows that in 2009, the last year for which data are complete, the US spent more than 17% of gross domestic product on health care. The next biggest spenders, France and the Netherlands spent 12% each.

We also know that the French and the Dutch have health outcomes that in many areas are better than ours and that their citizens are much happier with their health care than Americans are. Their systems are imperfect, too, but we should try to learn from them.
Unfortunately, rather than embracing the notion that we need to redesign our system, Congress is now getting ready to “squeeze” money out of the big areas of spending, like hospital care, without redesigning the system itself. Healthcare costs in our country are nothing more than a characteristic of the system we have to deliver health care. Every system is perfectly designed to get exactly the results that it gets. If we want a more cost-effective health care system, we need to design a new one.

Erin Golueke had a goal and she got in action. GBMC has a strategic vision of a changed system and we are building it. We need to stay in action. The ride may get a bit tougher now, but I have no doubt that we will get to a better place.

We’re doing great work at GBMC but we have to get even better at continually adding value to our care. If there are things we are doing that are not truly helping the patient then we need to get rid of them. We need to keep innovating to create a more coordinated system that delivers what the patient wants and needs – better health and better care at lower cost.

Do you have ideas to improve our current healthcare system? I welcome your thoughts.

If you would like to make a tax deductible gift toward Erin’s efforts, visit or call the GBMC Foundation at 443-849-2773.

Lastly, the annual GBMC Employee Opinion Survey is underway. As you know, we need the information that we get from employees to make improvements to make GBMC HealthCare a more joyful place to work! In the year that I have been here, we have made many changes on the basis of what you have told us. I also know that there are still many things that we need to improve, but we must hear from you to identify them. The survey is scheduled to end August 21.

Please complete your survey and encourage others to do the same!!